Our Formulary (Drug List) Structure

A formulary is a list of covered prescription drugs. Our drug list is reviewed and approved by an independent national committee comprised of physicians, pharmacists and other health care professionals who make sure the drugs on the formulary are safe and clinically effective.

Within the formulary, prescription drugs are divided into tiers. Depending on your plan, prescription drugs fall into one of four drug tiers which determines the price you pay. Some plans may have 3 or 4 tiers, so be sure to check your benefits information to see which tiers are included.

Members can view specific cost-share (copay or coinsurance) information by logging in to My Account or reviewing their annual summary of benefits.

The chart below describes a 4-tier drug plan:

Drug Tier (cost-share)

Definition

Tier 1Generic Drugs$

Generic drugs work the same as brand-name drugs, but cost less.

Tier 2Preferred brand$$

Preferred brand drugs are brand-name medications that do not have a generic equivalent. They are chosen for their effectiveness and affordability compared to alternatives. They cost more than generics but less than non-preferred brand drugs. If a generic drug becomes available, the preferred brand drug will be moved to the non-preferred brand category.

Tier 3Non-preferred brand$$$

Non-preferred brand drugs are often available in less-expensive forms, either as generic or preferred brand drugs. You will pay more for drugs in this tier.

Tier 4Self-administered injectables/Specialty drugs$$$$

These are the highest priced drugs and may require special handling, administration or monitoring. These drugs may be oral or injectable and are used to treat a serious or chronic condition.

Other Information

Serving Maryland, the District of Columbia and portions of Virginia. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueChoice, Inc., an affiliate company, also offers health benefit products and services on this site.